Big Red Bus Tour!

So Elise and I finished our first week at the Christie last Thursday and received a nice visit from our lovely professor, Dr. Ryan (international rotation coordinator for UK). We had coffee and then got back to work on our data entry.

Our project looks at patients diagnosed with advanced or metastatic renal cell carcinoma and their survival rates in comparison with published rates based on the targeted treatment they receive. Specifically, we are looking at the following drugs: sunitinib, sorafenib, and pazopanib. The NHS currently only recommends sunitinib and now pazopanib as first line for advanced renal cell carcinoma; however, patients have to meet certain criteria to receive pazopanib first line. The NHS funds drugs based on the guidance of a committee that sets the standard for healthcare.  The committee is called NICE (National Institute for health and Clinical Excellence) A bit different from the way things work in the states.

The goal sample size around 200 patients. Slowly but surely we are making our way! I'm really interested to start looking at the data we've collected and make some inferences from it!

So Thursday night, I left for London! I met up with my friend Jamie who lives just outside of London and was introduced to a few of his friends. Saturday we did the big red bus tour around the city, which was great. Below are pictures from the day:

Naturally I had to take a picture of this... :)

A Birthday Weekend & Some Old/New Updates!

First things first...I thought I took a lot of pictures; however, Elise has definitely taken over that role here. I have become her default model; therefore, I have borrowed a few pictures that she has taken of me.

This one here is of me working in our office at the college:


Here I am at lunch on Thursday afternoon at a place called Ford Maddox Brown. Really cute place & yummy too. I'm having to adjust to the fact that the majority of places we go to we order prior to sitting down. When we walked in we just sat at a table and just waited for our server but then we caught on!



Now - moving on to this last Friday. I jumped on a train (first one in a foreign country..woo!) to London to meet up with my friend Jamie. I was a bit nervous about getting lost so Elise came with me to the train station, very nice of her. And then I was nervous about making it on the RIGHT train and arriving in London in one piece. I'm slowly getting over my aversion to asking people for help. I always feel like such a bother but I figured that it was either ask the lady how to get on the train or be stuck at the Picadilly train station and here's why: as I sat and watched all these people get on the train, it looked to me as if the doors were opening automatically so I stared in confusion at the train car I was supposed to get on when the door didn't open for me. Apparently you have to press the magic button that says "push" in order for it to open. Shout out to the lady who informed me of this- THANKS!!



Needless to say, I got on the train, found my seat (had to ask for help on this one too!) and made it to London just fine! I have a weak stomach and tend to get sick anytime I'm in a moving object be it train, plane, or automobile, so I was surprised to find that the train was actually not a bad ride! I arrived at the London train station and made a B-line for the bathroom before going to look for Jamie. Did you know that you have to PAY to use the bathrooms there!?!? I also stood staring at the barriers to the bathroom with a confused look on my face before I realized that they really weren't joking. Fair or not, my need to use the bathroom after a 2 hour train ride and an entire bottle of water was necessary, so I coughed up my 30 pence.

I didn't have much trouble finding Jamie and after he dragged me up and down the train station escalators (j/k Jamie) we got on the "tube" to meet up with his "mummy", Pam :) also known as my favorite British mom. Ok ok..so she's the only British mom that I really know but she's still the best. We jumped in the car, headed to Jamie's sister & brother-in law's (Lucy and John) house in Somerset. (I think that's right!) Jamie provided me with my first experience with English motorways. I don't think that I'll be complaining about traffic in Kentucky anymore! Lucy was making chili for dinner. As a pseudo-Texas (pseudo because I have never lived in Texas but my mother and father are about as Texan as they come plus my family history is rooted there!) native, mexican food is a way of life so chili was music to my ears. We played rapidough (new game for me - but essentially it's like the sculpting part of cranium) I had informed Jamie that I was an excellent sculptor...which is true...so he was BEYOND lucky to be my partner; only thing was, he just wasn't that quick at guessing my art masterpieces made of play-do.

Saturday was Mrs. Payne's birthday outing. I felt so honored to be part of the whole ordeal. Lucy picked a wonderful restaurant & the food was amazing. I truly love birthdays and not because of the presents, although presents are great too. I always feel like I'm on top of the world when it's my birthday because it's a smack in the face reminder of how absolutely blessed I am. I do not know how I got so lucky to have the friendship of such amazing people, and I include the entire Payne family in that group! Saturday evening after the lunch outing was followed by chicken fajitas (again...refer to my love of Mexican food above) & games (spoons, card games, and the name game which was new to me..but I may be stealing it to take back to the states). I don't think I'll be able to stop myself from laughing when I think of Batman from here on out. Thanks Jamie for that!

Sunday we went for a dog walk. And I love that it's called that. The South of England reminds me of parts of Kentucky in a sense. It was absolutely gorgeous. I took just a few pictures while we were out walking! I completely forgot about taking pictures until the end! I wish that I had been in "tourist-mode" more! Lucy had planned a traditional English roast for lunch - which as fabulous! Thanks again Luce & John! :)



So today Elise and I started our stent at the Christie hospital where we will be doing data entry for a clinical trial in renal cell carcinoma.


Today we familiarized ourselves with the computer system and the data entry form we would be using. We already have a few adjustments to make to the form after beginning the pilot today! We are first performing a pilot data collection on roughly 20 patients to make sure that we are collecting all the necessary data. We received a tour of the hospital which was great. It functions primarily as a cancer hospital and now is moving more towards a hub for cancer research (largest in Europe). Currently there are ~150 clinical trials going on right now! CRAZY. The hospital is only 100 beds but they see about 12,000 new patients a year. Christie has been part of several historical landmarks in cancer research (i.e. being one of the first (or maybe the first) to use G-CSF to prevent neutropenia after chemotherapy. I find the role of G-CSF fascinating and just incredible that it is able to do what it does!

Despite having the same ultimate goal...our healthcare system in the states is different in so many ways. Geoff, one of the oncology specialist pharmacists is the lead on this particular clinical trial (renal cell) and the individual who gave us the tour. He informed us that the Christie outsources all of their IV chemotherapy. It is prepared off site and shipped to the Christie. The hospital can still prepare IV chemo (i.e. drugs used in clinical trials) if they need to but heavily rely on the outsourcing by Baxter (large manufacturer)for their patients. Geoff was explaining how he feels this allows him to be able to more fully do his job as a clinical pharmacist - ensuring that the right dose & right drug get to the right patient for the right indication! Essentially, I feel like we are moving towards he same direction in regards to IV preparation in the states as preparing chemo is often done by a technician, and a pharmacist just performs the final check. Patients also cannot just show up at the Christie unless they are registered with the Christie which is very different from how our hospitals in the states are! The GPs - general practitioners - are the the gate keepers for the NHS run healthcare system. I personally feel like that's the way it should be for us as well in the states. The ER is too frequently used as a GP in the states - leading to patients taking up the beds for those who really need emergent care! There has to be a happy medium between a system that is entirely government run and the system that we currently have in place. I'm going to get off my soapbox before this blog turns into a mini novel though! I could talk for hours on this topic!

Here is where we had lunch today! So thankful for the sunshine today! We sat outside...that was a first!

Water Isn't FREE?!?

Today is Day 4!

I feel like we've been here longer than four days. I think that may be due to the fact I'm more aware of things here. I like to think I'm a pretty observant person to begin with and now I feel like I'm on hyper drive...noticing all the little details, sizing up the different fashion trends, trying to read every little sign, and most importantly...vigilantly waiting for the little green man to light up so I know it's my turn to walk across the street. Refer to the first blog post. Cars really do not stop for you here...and neither do the cyclists!

So yesterday, Elise and I got my student card made. I wasn't able to do it the day before when Elise had because I left my passport in my room. I thought I was being internationally savvy as that was one of the travel tips recommended on the US Embassy site...well that turned out to be a big fail. The student center at the university needed my passport to copy so that they could issue my card..but I digress...so we got that all settled yesterday, got some morning work done, wrote my first post, and then we popped out for our downtown adventure. Our surrogate parent, Dr. Steinke (whom I found out today has an amazing first name to hear in a British accent, Douglas) wanted us to find the train station (Picadilly) and a few other places downtown (Primark (essentially a mix between Kohls and Forever 21) & Arndale Shopping center) so that we were more comfortable navigating the city. Excuse me...that would be Arndale shopping CENTRE. If I'm going to convince people I'm British, I need to start playing the part...which includes spelling things with extra letters.

The trip downtown was great. It started off with a much needed beverage...STARBUCKS.
Some things from America just cannot be replaced. Elise is much better at directions than I am so we found Picadilly (of course, not until after I insisted that the train station was in fact in a different direction and caused us to go in a circle) without much trouble. Now, we wanted to go by the Picadilly gardens..except the signs kept confusing us. Little did we know, we had passed it several times mistaking it for something else. Primark and Arndale are huge so it was not difficult finding those. I only brought along one granola bar for the day so I was starting to become a bit famished! **Side note** For those of you who do not know me well, I am a frequent snacker. I also have an addiction to fruit snacks. I brought over 3 boxes and I'm now down to one. I tried to ration myself...that didn't work out well. **Continuing on...Elise and I settled on a cute little Italian restaurant close by. I had a cup of soup & some bruschetta. I opted for a coke because the water was 2.50 pounds. Yup, that's right, water is not free. Elise and I may have freaked out when we read the menu. Someone may need to discuss this little issue with Parliament.

After lunch we began our trek back to the flat. We stopped off by the university to check out the Manchester museum. It is pretty tiny so we were surprised to learn that they had live animals! Manchester is like a mini-UN...so many cultures are represented here and learning a little bit about the history of the city was neat. Plus we got to color a picture when we got to the end of the museum. Before heading home, we popped into Sainsbury (giant grocery store...essentially like Kroger) and got some items for the rest of our week.

My dinner choice last night was good...tonights...not so much. I opted for this rice pilaf. I do not think I'll be purchasing that again.

Anyways, before we called it a night yesterday Elise and I went out for a beer at a place nearby (The Ram & Shackel) which was recommended by my dear friend Jamie (native Brit) whom I've known since 1st grade. Elise and I were surprised that with a name like Ram & Shackel that it was a pub. We caught the last part of the Poland vs. Russia football game! I was hoping Poland would win. We were a little disappointed that no one tried to come up and talk to us. I didn't think we stuck out too badly...however, my money issue at the bar may have given us away. I still have not caught on to how much each of the coins are worth. I generally have to pull all my coins out and flip each one over. How embarrassing. Maybe next time I'll be brave enough to walk up to someone and hopefully by the end of this week I can figure out how much change I have on me!

"UK" Takes On A New Meaning

We arrived into Manchester on Sunday morning around 10:30am. Frankly, I don't remember getting off the plane..or getting my bag off the conveyer belt. Was there even a conveyer belt?? I wish I could more adequately remember the details. I vaguely remember the airport being eerily quiet and feeling surprised when no one wanted to rummage through my bag at customs. I also thought it odd that there was only one lady at a desk stamping passports. For a first timer out of the US...this is not exactly what I was expecting. I was a little bummed that it was more laid back than the movies make it out to be.

So we met up with our supervisior/instructor/surrogate parent for our time here: Dr. Steinke. I had to apologize to him after the fact because I was still in an ambien-coma when we met him at the airport. Again..it was not difficult to find him. He must have been the only person aside from Elise and I in the airport. With two girls traveling, we were lucky to fit all our stuff in Dr. Steinke's car! We went straight to our home away from home...Oak House on the University of Manchester campus...except it's not really Oak House. See, we live in Fallowfield...Oak House is a subset there and our actual flat is in Sycamore Court. All very confusing. I'm not ever sure which place to say when people ask us where we are staying.

Apparently I signed our accommodation lease that I brought with me when we got to the main office. Don't remember that either. We received our keys to our flat (there are 3 of them by the way) and went to move our stuff in.

So..the flat. There are two bedrooms, a living room, a dining room area, a kitchen, and a bathroom. There are also doors to every room. Fire doors. It makes socializing with one another difficult. We kind of have to scream at one another when we are in our own rooms. I thought we both would have a twin bed, but one of the beds is more of a full so my sheets didn't exactly fit. Thankfully Dr. Steinke not only supplied us with pots and pans but he also brought over some big blankets. The blankets were also extremely necessary due to the fact it is freezing here. Elise and I are now frequent flyers to the main office. We were hoping they would tell us a way to turn on the heat in our flat only to be informed that the heat had been shut off since it was "summer." I'm still trying to wrap my mind aroudn that one. So our next visit to the main office was due to the fact we thought we were locked out of our flat. Turns out our keys work just fine and the poor man had to come walk all the way to our flat just to prove it to us. Next trip to the main office was to figure out how to get internet in our flat. They had previously given us cords but we still weren't able to connect. Once they removed the old tennants names from the flat, we had internet. Praise the Lord.

After we both crashed for several hours the first day, Elise and I ventured out to find some food...but first, we needed money. Remember, I was comatose at the airport, so I didn't think about obtaining any pounds(£) So after the first machine just about ate my card...traumatic experience for me...we managed to find a bank (thank you NatWest) that supplied us with British currency so that we could eat. The menu was difficult to read. We weren't quite sure what we were ordering but we went with : chicken sandwich on naan. Maybe next time we will try the barm.
Naan: Indian flatbread...essentially a pita pocket

Despite speaking the same language, England is quite different. And frankly...I challenge the idea that we speak the same language. (see above with food incident) I have already been very confused at some of the phrases that have come out of peoples mouths here. Here is my list of major differences so far:
--traffic has the right a way. There are practically no cross walks...which of course doesn't bother me too much since I "j-walk" in the US all the time.
--The electricity is not only different but the Brits love switches. You have to turn each outlet on to obtain power
--tea breaks really are a must here
--the keys on the keyboard are in different places
--there is no "pulley" string on buses to alert the driver when you need to get off
--we really are not on the same weather pattern....this weather honestly cannot be called "summer"
--ketchup packets are not free.

That's all I have for now as far as differences go. I'm sure the list will continue to expand as my time here continues.

The agenda today is:
-get student card
-find picadilly train station, self ridges, and primark
-explore downtown manchester
-try not to get lost or stick out too much. my ultimate goal every day.

Oh and mom-- don't worry. I already found a church. It's actually right by the college of pharmacy building!

All in all, I'm really enjoying myself. It's fascinating to learn about another culture. Elise and I have already been picking Dr. Steinke's brain about the Mpharm program here and the NHS health system. I find it all so interesting. Can't wait until we get started with the data collection for the RCC (renal cell carcioma) project.